CML was once considered a death sentence, with people typically living only a few years after being diagnosed. But have TKI medications, such as Gleevec, Sprycel, Tasigna or Bosulif, actually made a difference?
Yes – according to an analysis of people enrolled in the German CML Study IV (Saussele and colleagues. Blood 2015;126:42-49; free full text at www.ncbi.nlm.nih.gov/pmc/articles/PMC4574015/).
The purpose of the analysis was to look at the impact of other illnesses (“comorbidities”) on people living with CML and being treated with Gleevec over a five-year period. People were stratified according to the number and severity of their other illnesses, such as diabetes, heart disease, lung disease and kidney disease. As you might expect, the sickest people at the start of the study were older (median age 68-72) than those with fewer illnesses (median age 39-57).
There were no differences among the groups with respect to their likelihood of achieving a complete cytogenetic response (CCyR) or major molecular response (MMR). The median time to reach these two treatment-response milestones was 13-14 months and 16-20 months, respectively. In addition, the risk of progressing to accelerated-phase or blast-crisis CML in the first five years of treatment was comparably low among the different groups (about 5-10%).
Where there was a difference was in overall survival. The five-year survival for people with less comorbidity was 93.6%, whereas for the sickest group it was 46.4%. The reason for this difference was the number and severity of their other illnesses.
Two important conclusions can be made from this study. The first is that TKIs (Gleevec in this case) appear to work well in people of different ages, and that being older or having other illnesses doesn’t affect a person’s likelihood of having a response to a CML treatment. Secondly, for a person living with CML, the odds are that CML will not be the cause of death – a situation very different from how things were only a decade ago. Medications can transform CML into a manageable, chronic illness. Aging and other illnesses will take their toll, however, so it’s important to maintain your overall good health while treating your CML.